Does Medicare Cover Eye Exams?

While Original Medicare (Part A and Part B) doesn't typically cover eye exams, Medicare Advantage (Part C) plans may cover routine vision care including eye exams and prescription eyeglasses and contact lenses.

99% of Medicare Advantage plans offered vision benefits in 2023, according to the Kaiser Family Foundation.¹

Medicare Advantage plans that cover eye exams may not be available where you live. Carefully review plans that are available where you live, including what - if any - vision services they cover and at what cost. 

If a Medicare Advantage plan covers routine vision services like eye exams, some covered services may require additional costs such as copays, coinsurance, deductibles or additional premiums.

What Part of Medicare Pays for Eye Exams?

Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), does not provide coverage for routine eye exams that are meant to check your vision or prescribe glasses.

However, in certain medical cases, Original Medicare may cover eye exams or vision care services. 

• For example, if you have glaucoma, age-related macular degeneration or a high risk of developing diabetes, Original Medicare may cover an annual eye exam or other diagnostic tests.
  
  
• Original Medicare Part B may also cover services related to eyesight, such as cataract surgery or other medically necessary diagnostic tests and procedures. If you have cataract surgery that includes an intraocular lens implant, Medicare covers prescription glasses one time with standard frames.

There are alternatives to Original Medicare coverage that may help pay for routine eye exams that Original Medicare doesn't cover.

Also known as Medicare Part C, Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans are required to cover everything Original Medicare covers, and plans may include additional benefits beyond what Original Medicare cover, such as vision, dental and prescription drug coverage.

Compare available options in your area by requesting a free plan quote or by calling to speak with a licensed insurance agent who can help you shop for Medicare plans that cover eye exams.

When Does Medicare Pay for Eye Exams for Diabetes?

Part B covers 80% of the approved amount for an annual eye exam related to diabetes or glaucoma once every 12 months, after you meet your annual Part B deductible. 

If you have a Medicare Advantage plan, your coinsurance, copay and deductible amounts may vary.

Does Medicare Cover Eyeglasses for Seniors?

Original Medicare does not cover eyeglasses or contact lenses, except in certain cases after cataract surgery that implants an intraocular lens. Some Medicare Advantage plans may offer vision care benefits that cover prescription glasses or corrective lenses.

Conclusion

Original Medicare does not cover routine eye exams. However, there are other options available such as Medicare Advantage plans that may offer vision care benefits.

You can learn more and compare the vision benefits that may be available with Medicare Advantage plans in your area by calling to speak with a licensed insurance agent or by requesting a free plan quote online.

We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.